Occupational Medicine Advance Access originally published online on November 2, 2006
Occupational Medicine 2007 57(1):57-66; doi:10.1093/occmed/kql125
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Carpal tunnel syndrome and its relation to occupation: a systematic literature review
MRC Epidemiology Resource Centre, University of Southampton, UK
Objectives To assess occupational risk factors for carpal tunnel syndrome (CTS), we conducted a systematic literature review.
Methods We identified relevant primary research from two major reviews in the 1990s and supplemented this material by a systematic search of the MEDLINE and EMBASE biomedical databases from the start of the electronic record to 1 January 2005. Reports were obtained and their bibliographies checked for other relevant publications. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect.
Results Altogether, we summarized 38 primary reports, with analyses based either on a comparison of job titles (22) or of physical activities in the job (13) or both (3). We found reasonable evidence that regular and prolonged use of hand-held vibratory tools increases the risk of CTS >2-fold and found substantial evidence for similar or even higher risks from prolonged and highly repetitious flexion and extension of the wrist, especially when allied with a forceful grip. The balance of evidence on keyboard and computer work did not indicate an important association with CTS.
Discussion Although the papers that we considered had limitations, a substantial and coherent body of evidence supports preventive policies aimed at avoiding highly repetitive wrist–hand work. There is a case for extending social security compensation for CTS in the United Kingdom to cover work of this kind.
Keywords Carpal tunnel; classification; neuropathy; occupational risk factors
Correspondence to: Keith T. Palmer, MRC Epidemiology Resource Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. Tel: +44 23 8077 7624; fax: +44 23 8070 4021; e-mail: ktp{at}mrc.soton.ac.uk
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